Epidural childbirth is one of the many options that are available to women today that provides pain relief during the whole process of childbirth, labour and delivery. Epidural anesthesia works by blocking pain during labor and childbirth in two ways. A local anaesthetic is given to block nerves from conducting electrical messages from the vagina and uterus to the brain. On top of this, an analgesic is given to provide pain relief in the spinal cord.
Unlike a general anaesthetic, you will still be fully conscious and also not completely numb during, still being able to feel some sensation during the birth process and also participate physically in labor and childbirth to some extent.
The Process of Epidural Labour
The first thing that happens during epidural anesthesia, is the administration of a local anaesthetic to numb the skin on your back before the needle is inserted into the lumbar vertebra. You will also be put on a drip via a vein in your arm to maintain fluid levels and stablize blood pressure. You can experience a drop in blood pressure during labour when an anaesthetic is given as blood vessels are relaxed. This reduces the rate at which blood returns to the heart.
Once the local anaesthetic has worked, as you lie on your side, the needle will be inserted into the epidural space inside the lumbar vertebra in your spine. Hopefully there will only be one attempt to find the right place, although when I had an epidural it took the anaesthetist three attempts. If all goes well a small, thin tube relays the anaesthetic fluid into the spine. When needed, more anaesthetic fluid can be administered.
Anesthesia has become a lot more sophisticated than in the past. Nowadays, specific nerves can be selected that block the pain, but still enable you to move to some extent. This then gives you the choice of position during birth. Instead of being completely numb, you still have some sensation in your abdomen and legs. However, the pain will be completely reduced. It is often thought that epidurals are solely for the purpose of an inactive operative birth. But this is not the case at all. You can still have a vagina birth if you choose to do so.
The sophisticated methods ofmean that you may not need the addition of contraction stimulating drugs. This is a good thing as it places less on your baby. This form of epidural which is selective in blocking certain nerves is known as a mobile epidural. It normally kicks in within half an hour. The dose is reapplied as needed, according to the level of pain in labour, usually every hour or so. The mobile epidural can be given any time during labour. However, it is usually preferred during the early stages of labour.
Full Epidural Childbirth
This is the type of epidural that numbs from the waist down. All associated muscles are also temporarily paralysed. This includes the bladder muscles, so you will usually be given a catheter as you will not be able to control your own urine flow. The anaesthetic administered during this procedure is much more concentrated than in the mobile epidural. Because of your temporary paralysis, the midwives will often ask you to sit up in order to promote blood flow to the placenta. This stronger dose of the anaesthetic doesn’t wear off as quickly as the mobile epidural, lasting for up to 5 hours or more. If asection becomes necessary, the full epidural is chosen.
The ebb and flow of pain relief made possible during epidural childbirth allows women several options. For some, it can provide an opportunity to switch off the pain during labour and rest. After recovering some strength, some women choose to let the epidural wear off and not opt for a top up. They then decide to give birth naturally as the rest has enabled them to muster the strength.
Another option is to go through the entire birth with the epidural being periodically topped up to provide pain relief all the way through. If obstetric intervention is required, such as a caesarean section, or other means of delivery likeor , then the epidural is already there to be taken advantage of. Another benefit of epidural childbirth is that if the birth did involve obstetric surgery, then the anaesthetic can be regularly topped up over the next day and ½ to provide post operative pain relief.
Epidural Side Effects After Birth and During Labour
Nowadays the improved skills of anaesthetists, midwives and obstetricians means that there is a much lower incidence of medical mishaps during epidural childbirth. One of the benefits of improved technique is that a much lower dose of anaesthetic is needed. However there are some side effects which should be mentioned.
- Because of the way anaesthetic affects muscles, there may be a decrease in the power of your contractions. This effect is increased if you’re lying on your back and this is why you sometimes are asked to sit upright or even put into an upright position. Oxytocin is usually administered in these situations to stimulate contractions.
- Although not such a problem with mobile epidural, there is a possibility of foetal distress. The two main problems with anaesthetic in labour is that it can reduce blood pressure and reduce blood flow. This means that the flow of blood to the baby via your placenta can be decreased to the point where it becomes dangerous. Another problem is that some of the anaesthetic may enter the baby’s bloodstream which can cause its heart beat to slow down. The first step taken to remedy this is usually to increase the flow of fluid from the drip but if this doesn’t work then obstetric intervention may be required.
- Sometimes the epidural may not have fully worked. This can be caused by nerves not being blocked properly in a certain area of the spine. This can lead to pain in a specific area while other areas may still be completely pain free. Usually if this happens the epidural is repositioned.
- Another problem that is possible with a full epidural childbirth is that because of the temporary muscle paralysis in the pelvic area, the head of the baby may not rotate to a forward position at the correct time. Both mother and baby are monitored, and if no foetal distress is picked up, then the midwives may just decide to wait a bit longer. It is always best for the baby’s head to be in the correct position before bearing down as this usually results in a normal birth. If, however, things do not go to plan, then it may be necessary to use forceps or even a ventouse delivery.
- Bladder problems are quite rare and it is usually the case that you still have some sensation in your bladder with a mobile epidural. If you have sensation then it is usually the case that you can pass urine as normal. However, sometimes a catheter may be necessary even with a mobile .
- Spinal pain can be a problem even weeks after an . There could be various reasons for this, but it would usually be due to some kind of nerve damage during the procedure. The problem usually resolves itself. I had pain that lasted about a month after my epidural. However I noticed that once I started exercising again the pain seen to go within a matter of days. Some people swear by yoga or osteopathy as post epidural childbirth pain solutions.
- Sometimes in the case of a full epidural where a higher dose of anaesthetic is used, other areas of the body apart from below the waist can be affected. Sometimes the muscles which control breathing, or rather the nerves that control them, can also be affected. If this happens you may need to be put on an artificial ventilator until the dose wears off and your breathing returns to normal. This is why most hospitals nowadays prefer to opt for the lower dose mobile epidural in childbirth as there are far fewer side effects due to the lower concentration of anaesthetic needed.
- One other problem that can occur with epidural childbirth is a drop in the cerebrospinal fluid pressure. This problem can occur if the needle penetrates the dural space. This can lead to a severe headache, potentially lasting for up to 72 hours or longer in some cases. Fortunately, with enough rest, the cerebrospinal fluid pressure should return to normal if correctly treated in less than a week.
Benefits of Epidural Childbirth
- Most of the above complications are quite rare. The positives of epidural childbirth still outweigh the negatives.
- It is the best way of relieving pain while still maintaining awareness of the whole birth process.
- Unlike a general anaesthetic there are far fewer dangers.
- It can actually help dilate the cervix.
- It provides an opportunity to rest during labour and replenish your energy reserves.
- Most importantly if obstetric intervention is required such as a caesarean, forceps delivery or ventouse, the doctors can take action immediately.